A term infant is born vaginally to a mother who screened GBS positive at 36 weeks. She received IV penicillin G 6 hours before delivery, membranes were ruptured for 5 hours, and she was afebrile. The infant is vigorous with normal vital signs. Which plan is MOST appropriate?

Routine newborn care, because the intrapartum prophylaxis was adequate

Blood culture and empiric ampicillin and gentamicin until results return

Blood culture and CBC, then observation for 48 hours in the nursery

A 38-week infant born by scheduled cesarean without labor has a respiratory rate of 84 with mild retractions at 2 hours of age. SpO2 is 94% in room air, and the chest x-ray shows fluid in the fissures with hyperinflation. The nurse should expect:

Supportive care with improvement over about 24 to 72 hours

Surfactant therapy through an endotracheal tube

Needle aspiration of the chest after transillumination

A 2-day-old infant has repetitive lip smacking, a fixed horizontal eye deviation and brief apnea without bradycardia. Glucose is 72 mg/dL. Which interpretation is MOST likely?

Subtle seizures that require prompt evaluation and treatment

Normal sleep movements that require no further evaluation

Jitteriness from caffeine withdrawal that will resolve alone

Before an intermittent gavage feeding, which method should the nurse use to verify orogastric tube placement?

Check the external length mark and aspirate pH per protocol

Listen over the stomach while injecting a small bolus of air

Place the end of the tube in water and watch for bubbling

A 34-week infant under a radiant warmer in servo mode has an axillary temperature of 38.1 °C. The warmer displays a skin temperature of 35.2 °C and maximal heater output. What should the nurse check FIRST?

Whether the skin probe has come loose from the skin

Whether the room air temperature is set too high

Whether the infant needs a blood culture for fever

A mother with systemic lupus erythematosus has anti-Ro (SSA) antibodies. Her 38-week infant has a steady heart rate of 68 at rest, is pink and active, and has a capillary refill of 2 seconds. What should the nurse do FIRST?

Obtain a 12-lead ECG and notify the provider

Begin chest compressions coordinated with ventilation

Give IV atropine and repeat it every 5 minutes until the rate rises

A 42-week infant born through thick meconium has tachypnea, a barrel chest and patchy infiltrates with areas of hyperinflation on x-ray. In addition to respiratory support, the nurse should monitor MOST closely for:

Pneumothorax and pulmonary hypertension

Hyperglycemia and hypercalcemia

Necrotizing enterocolitis and bowel perforation

A 30-week infant on day 2 suddenly becomes hypotonic with repeated apnea and a tense anterior fontanelle. The nurse compares the current results with those from admission, listed below. Measure Admission Now Hematocrit 45% 33% Mean blood pressure 32 mm Hg 24 mm Hg Head circumference 28.0 cm 28.6 cm Which complication is MOST likely?

Hypoxic-ischemic encephalopathy

The mother of a 32-week infant asks why human milk fortifier is being added to her pumped milk. Which response by the nurse is MOST accurate?

It adds protein, calories and minerals your baby needs to grow

It is used because your milk supply is not yet high enough

It replaces the antibodies that pumping removes from your breast milk

A 2-day-old term infant rooming in has an axillary temperature of 37.9 °C. The infant is wearing a hat and a sleeper under three blankets and is feeding well with normal tone and color. What should the nurse do FIRST?

Unbundle the infant and recheck in 15 to 30 minutes

Give acetaminophen and recheck in 1 hour

Draw a blood culture and notify the provider of fever

Low Risk Neonatal Nurse Exam

Free Low Risk Neonatal Nurse Practice Questions

10 sample questions for the Low Risk Neonatal Nurse Exam, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Maternal Risk Factors and Birth History, Physical and Gestational Age Assessment, Cardiovascular and Respiratory Conditions, Gastrointestinal, Genitourinary, Musculoskeletal and Integumentary Conditions, Laboratory and Diagnostic Data, Resuscitation, Stabilization, Thermoregulation and Oxygenation, Nutrition, Feeding, Fluids, Electrolytes and Glucose, Pharmacology and Pain Management, Neurodevelopmental Care, Infection and Immunology, Family Support, Discharge Planning and Professional Issues.

Question 1 · Maternal Risk Factors and Birth History
A term infant is born vaginally to a mother who screened GBS positive at 36 weeks. She received IV penicillin G 6 hours before delivery, membranes were ruptured for 5 hours, and she was afebrile. The infant is vigorous with normal vital signs. Which plan is MOST appropriate?
- A.Routine newborn care, because the intrapartum prophylaxis was adequate
- B.Blood culture and empiric ampicillin and gentamicin until results return
- C.Blood culture and CBC, then observation for 48 hours in the nursery
Show answer and explanation
Answer: A. Routine newborn care, because the intrapartum prophylaxis was adequate
Penicillin, ampicillin or cefazolin given at least 4 hours before birth is adequate GBS prophylaxis, so a well-appearing term infant needs only routine care. Laboratory screening is not indicated for a well infant after adequate prophylaxis, and empiric antibiotics are reserved for ill-appearing infants or higher-risk situations.
Question 2 · Cardiovascular and Respiratory Conditions
A 38-week infant born by scheduled cesarean without labor has a respiratory rate of 84 with mild retractions at 2 hours of age. SpO2 is 94% in room air, and the chest x-ray shows fluid in the fissures with hyperinflation. The nurse should expect:
- A.Surfactant therapy through an endotracheal tube
- B.Needle aspiration of the chest after transillumination
- C.Supportive care with improvement over about 24 to 72 hours
Show answer and explanation
Answer: C. Supportive care with improvement over about 24 to 72 hours
Cesarean birth without labor, early tachypnea and fluid in the fissures are typical of transient tachypnea of the newborn from delayed lung fluid clearance. It is managed with supportive care and resolves over 1 to 3 days. Surfactant treats surfactant deficiency with a ground-glass pattern, and needle aspiration treats a pneumothorax.
Question 3 · Physical and Gestational Age Assessment
A 2-day-old infant has repetitive lip smacking, a fixed horizontal eye deviation and brief apnea without bradycardia. Glucose is 72 mg/dL. Which interpretation is MOST likely?
- A.Subtle seizures that require prompt evaluation and treatment
- B.Normal sleep movements that require no further evaluation
- C.Jitteriness from caffeine withdrawal that will resolve alone
Show answer and explanation
Answer: A. Subtle seizures that require prompt evaluation and treatment
Subtle seizures are the most common type in newborns and include oral-buccal movements, eye deviation and apnea without bradycardia. They need prompt evaluation for causes such as electrolyte disorders, infection and HIE, EEG monitoring and treatment. Sleep movements do not include sustained eye deviation, and jitteriness is a tremor of the limbs that stops with restraint.
Question 4 · Nutrition, Feeding, Fluids, Electrolytes and Glucose
Before an intermittent gavage feeding, which method should the nurse use to verify orogastric tube placement?
- A.Listen over the stomach while injecting a small bolus of air
- B.Place the end of the tube in water and watch for bubbling
- C.Check the external length mark and aspirate pH per protocol
Show answer and explanation
Answer: C. Check the external length mark and aspirate pH per protocol
Confirming that the tube is still at the measured external mark and testing aspirate pH, with x-ray confirmation when needed per protocol, are more reliable than auscultation. Air insufflation sounds can be heard even when the tube is in the esophagus or lung. Bubbling in water is not a valid placement test.
Question 5 · Resuscitation, Stabilization, Thermoregulation and Oxygenation
A 34-week infant under a radiant warmer in servo mode has an axillary temperature of 38.1 °C. The warmer displays a skin temperature of 35.2 °C and maximal heater output. What should the nurse check FIRST?
- A.Whether the room air temperature is set too high
- B.Whether the skin probe has come loose from the skin
- C.Whether the infant needs a blood culture for fever
Show answer and explanation
Answer: B. Whether the skin probe has come loose from the skin
When the displayed skin temperature is far below the infant's measured temperature and the heater is at full output, a detached probe is reading air, so the warmer keeps heating and causes iatrogenic hyperthermia. The nurse resecures the probe on a flat area of the abdomen, not under the infant or over bone, and rechecks the temperature. A sepsis workup or room temperature change is not the first step when equipment error explains the reading.
Question 6 · Maternal Risk Factors and Birth History
A mother with systemic lupus erythematosus has anti-Ro (SSA) antibodies. Her 38-week infant has a steady heart rate of 68 at rest, is pink and active, and has a capillary refill of 2 seconds. What should the nurse do FIRST?
- A.Obtain a 12-lead ECG and notify the provider
- B.Begin chest compressions coordinated with ventilation
- C.Give IV atropine and repeat it every 5 minutes until the rate rises
Show answer and explanation
Answer: A. Obtain a 12-lead ECG and notify the provider
Maternal anti-Ro antibodies can damage the fetal conduction system and cause congenital complete heart block, which presents as a steady slow rate in an otherwise well infant. An ECG confirms the rhythm, and the provider decides on cardiology consultation and pacing needs. Compressions are not indicated in a well-perfused infant, and atropine does not reliably treat complete heart block.
Question 7 · Cardiovascular and Respiratory Conditions
A 42-week infant born through thick meconium has tachypnea, a barrel chest and patchy infiltrates with areas of hyperinflation on x-ray. In addition to respiratory support, the nurse should monitor MOST closely for:
- A.Hyperglycemia and hypercalcemia
- B.Necrotizing enterocolitis and bowel perforation
- C.Pneumothorax and pulmonary hypertension
Show answer and explanation
Answer: C. Pneumothorax and pulmonary hypertension
Meconium aspiration causes airway obstruction with air trapping and chemical pneumonitis, which raise the risk of air leak and persistent pulmonary hypertension. Sudden deterioration or a widening pre- and postductal saturation difference should be reported at once. Hyperglycemia and hypercalcemia are not expected effects of meconium aspiration, and necrotizing enterocolitis with perforation is an intestinal complication seen mainly in preterm infants, not a characteristic complication of this lung disease.
Question 8 · Physical and Gestational Age Assessment
A 30-week infant on day 2 suddenly becomes hypotonic with repeated apnea and a tense anterior fontanelle. The nurse compares the current results with those from admission, listed below.
Measure Admission Now
Hematocrit 45% 33%
Mean blood pressure 32 mm Hg 24 mm Hg
Head circumference 28.0 cm 28.6 cm
Which complication is MOST likely?
- A.Necrotizing enterocolitis
- B.Hypoxic-ischemic encephalopathy
- C.Intraventricular hemorrhage
Show answer and explanation
Answer: C. Intraventricular hemorrhage
Preterm infants are at highest risk for intraventricular hemorrhage from the fragile germinal matrix in the first days of life. A large bleed presents with sudden neurologic decline, a tense fontanelle and a falling hematocrit, and a head ultrasound confirms it. NEC presents with abdominal signs, and HIE follows a perinatal hypoxic event and is present from birth.
Question 9 · Nutrition, Feeding, Fluids, Electrolytes and Glucose
The mother of a 32-week infant asks why human milk fortifier is being added to her pumped milk. Which response by the nurse is MOST accurate?
- A.It is used because your milk supply is not yet high enough
- B.It replaces the antibodies that pumping removes from your breast milk
- C.It adds protein, calories and minerals your baby needs to grow
Show answer and explanation
Answer: C. It adds protein, calories and minerals your baby needs to grow
Preterm infants have higher needs for protein, energy, calcium and phosphorus than unfortified human milk supplies, so fortifier supports growth and bone mineralization. Pumping does not remove antibodies, and fortifier is not a replacement for low supply. The mother should know her milk remains the preferred base feed.
Question 10 · Resuscitation, Stabilization, Thermoregulation and Oxygenation
A 2-day-old term infant rooming in has an axillary temperature of 37.9 °C. The infant is wearing a hat and a sleeper under three blankets and is feeding well with normal tone and color. What should the nurse do FIRST?
- A.Unbundle the infant and recheck in 15 to 30 minutes
- B.Give acetaminophen and recheck in 1 hour
- C.Draw a blood culture and notify the provider of fever
Show answer and explanation
Answer: A. Unbundle the infant and recheck in 15 to 30 minutes
A mildly elevated temperature in a well-appearing, overbundled infant is most often environmental, so the nurse removes excess clothing and blankets and rechecks shortly. If the temperature stays elevated after unbundling, or other signs of illness appear, the nurse notifies the provider because fever in a newborn may signal sepsis. An antipyretic would mask a true fever and is not given before evaluation.

Measure	Admission	Now
Hematocrit	45%	33%
Mean blood pressure	32 mm Hg	24 mm Hg
Head circumference	28.0 cm	28.6 cm

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